How to build a national emergency phone service

This year is the 80th anniversary of the world’s first national emergency phone service, the UK’s 999. In the week of the 30th of June 1937 the number received 1,000 calls in its launch in the city of London. The idea came from a government committee set up after five people died in a fire at a London doctor’s surgery in 1935. Glasgow was the second city, but the War delayed further roll-out until 1948 for all major towns and cities. Today, the service handles 560,000 calls a week.

In wealthy countries we take for granted such services as always present and universal. I for one was not aware of how long it took to scale up a service that was envisaged as national, nor the circuitous routes required for scale. Every country has to find its own way.

USA

Bringing a national system to the enormous United States is more complex and took longer. As early as 1921, New York City’s Bellevue Hospital received 2,500 emergency calls per day. People struggled to remember the number of the local fire service. Others dialled 0 for the operator, waiting with every other person dialing for non-emergency reasons.

Switching to a national single system was hard. Vintage ambulances were hearses. In some rural towns these hearses were also used by funeral home employees, nor was AT&T required to serve these rural areas with 911 coverage.

The Robert Wood Johnson Foundation stepped in. Founded in 1972 by Robert Wood Johnson II, whose father had started Johnson & Johnson, the billion-dollar foundation started with a $15 million grant focusing on poorly served rural areas, including providing 911 coverage.

In 1973, only 11 percent of people in the areas supported by the Johnson Foundation program had access to 911, or some equivalent emergency phone number. By the program’s end, in 1977, 95 percent of them did. These outcomes were not mirrored in the nation as a whole. In 1979, only 25 percent of the U.S. population was covered by 911 or its like.

In this way, Foundation dollars were the spur that encouraged subsequent federal support.

India

One night in India, Shaffi Mather’s mother awoke in the middle of the night choking and unable to breathe. The family did not know what to do or who to call so they chose to drive her to the hospital themselves. Just a few days later, Ravi Krishna’s mother collapsed in New York but was attended to within minutes by a 911 ambulance. Ravi and Shaffi were struck by the difference for their mothers. How would one start a national ambulance service in India?

In 2004 Ziqitza Health Care started with one ambulance and the phone number 1298. It was founded by Shaffi, Ravi, with Sweta Mangal, Naresh Jain, and Manish Sancheti. Today they have 2,100 ambulances which have helped over 6.8 million people get to hospital. With no government funding, the price is paid by the patients. But from the beginning the team wanted a pay-what-you-can model, and had an honour system. Too many people claimed to be too poor to pay. The team figured out the model when they tied the price to the hospital the patient asked to go to. The more expensive the hospital the more the ambulance charged for the ride. Acumen Fund invested when they saw the social impact of the service: the Fund “raises charitable donations to invest in companies, leaders, and ideas that are changing the way the world tackles poverty”. Ziqitza became the largest ambulance transport company in Asia.

What number works best?

The UK government’s committee originally considered 707, which corresponded to the letters SOS. In the end 999 was chosen as more practical in the days of rotary phones as it was easy to remember but not easy to spin by accident. New Zealand’s phones, with the reverse rotation of numbers as the UK’s, meant 111 was the number. By the time the USA’s service had started, buttons on phone were becoming common, and the dialing 999 by accident was more likely than 911. Today, smartphone touch screens (and babies) make a lot of accidental calls. But emergency service staff continue to adjust and modernise, savings lives all over the world.

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